1. Task shifting and regulatory frame work, Ethiopia Yibeltal Assefa National HIV/AIDS prevention and control office Task shifting and regulatory frame work, Ethiopia Yibeltal Assefa National HIV/AIDS prevention and control office June 14,2007 Kigali

2. Background  Population around 78 million  National adult HIV prevalence- –ANC based- 3.5  PLWHAs - 1.3 million (ANC data)  Need ART----280,000  More than 150, 000 people are started on chronic care.  More than 90,000 people are started on ART

4. ART Site Expansion ART Site Expansion

5. HEW and the Ethiopian heath system  The Ethiopian health system is organised around the concept of the HNW model with different components: –PHC (community, health posts and health centres) providing service for 25,000 people –Hospitals of different levels  HEW are assigned at the Health post

6. Health extension workers  They are community health workers assigned at the health post  Two HEW provide service for 5000 people at each health post  More than 9000 HEW are already deployed  We have planned to produce 30,000 HEW in total (two per Kebele or health post).  Their main task is preventive and promotive (very little on curative)

7. The process of introduction of HEW (The regulatory frame work)  MOH raised the need to introduce HEP as a vehicle to attain MDGs  MOH Proposed : –the components of the package and key intervention area – duties and responsibilities of the HEW –Proposed Recruitment criteria –Duration and training Methodology

8. The process, contnd…  All relevant ministries and bodies were involved from the inception –MOCB- approves Keble level civil service structure –Civil service agency-approves minimum job requirements and grading –MOE –MOFED –CBO/FBO  The process has taken almost two years

9. Recruitment  Female –Empowerment –Easily accepted by the community –Can stay longer in the community  High school graduates  Selected by the community  Need to speak the local language

10. Training and Deployment  A one year training  Both class room and practical sessions  After completion they will be certified  They need to go to their locality after graduation  Defined career structure and promotion  System designed for continuous ongoing training  Working condition – 75% outreach and 25% at Health post  Supervises 15-20 Voluntary CHWs

11. M&E and quality& safety  There is a plan to really evaluate whether the HEW are doing what they are supposed to do they are supposed to do  As part of the HNW they are also considered to be mentored by the health centre staff

12. Summary  HEW has been planned with a greater involvement of the concerned bodies from the very beginning and its implementation is also being monitored with all the concerned parties so that it will be effective and sustainable.